By NextBestFitGold-carding and automatic approvals
Exempt clinicians with high approval rates; require real-time electronic decisions; ban prior authorization for routine and chronic care.
Interim relief for clinicians.
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This path
Gold-carding and automatic approvals
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Exempt clinicians with high approval rates from prior authorization
- Require electronic real-time decisions
- Ban prior authorization for routine and chronic care
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Prior authorization delays and blocks care
Exempting clinicians with strong approval records, requiring immediate electronic decisions, and removing authorization for routine and chronic care reduces paperwork for high-performing clinicians. Their patients receive care faster.
What it creates or worsens
- Raises spending or loosens control over it
Authorization exemptions remove an insurer cost-control tool.
- Solves only part of the problem
Few physicians qualified for the Texas exemptions during the early implementation period.
Who's affected
Who gains
- People with ongoing or specialist care needs
- Prior authorization delays and blocks care: Approval requirements delay treatment and can cause harm.
- Doctors, nurses, and other clinicians
- Prior authorization delays and blocks care: Approval requirements take time from physicians and staff.
Who loses
- Health insurers, brokers, and their shareholders
- Prior authorization delays and blocks care: They control treatment approval through prior authorization.
- Health administration and software vendors
- Prior authorization delays and blocks care: They supply utilization-management services for approval requirements.
- Taxpayers and public budgets
- Raises spending or loosens control over it: Public budgets pay the added spending.
Where it has been tried
- Texas (2021): HB 3459 (2021) exempts physicians with 90%+ approval rates over six months, but only in state-regulated plans (about a fifth of the market).
- Texas: A 2024 Texas insurance department report found that 74% of providers meeting evaluation thresholds received a prior-authorization gold card.Sources: Texas Department of Insurance (2024)